Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis

2017 ◽  
Vol 46 (11) ◽  
pp. 2798-2808 ◽  
Author(s):  
Blake M. Bodendorfer ◽  
Andrew J. Curley ◽  
Joshua A. Kotler ◽  
James M. Ryan ◽  
Neha S. Jejurikar ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lower Extremity ◽  
Complication Rate ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Nonoperative Treatment ◽  
Functional Scale ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring ◽  
Lower Extremity Functional Scale

Background: No meta-analysis has compared outcomes of operative and nonoperative proximal hamstring avulsion treatment. Purpose: To compare outcomes of operative and nonoperative proximal hamstring avulsion treatment, including acute, chronic, partial, and complete repairs. Study Design: Meta-analysis. Methods: PubMed, CINAHL, SPORTdiscus, Cochrane Library, EMBASE, and Web of Science were searched up to July 2016. Three authors screened the studies and performed quality assessment using criteria from the Methodologic Index for Nonrandomized Studies. A best evidence synthesis was subsequently used. Results: Twenty-four studies (795 proximal hamstring avulsions) were included. Twenty-two studies included proximal hamstring avulsion repairs; 1 study had proximal hamstring avulsion repairs and a control group of nonoperatively treated proximal hamstring avulsions; and 1 study had solely nonoperatively treated proximal hamstring avulsions. The majority of studies were of low methodological quality. Overall, repairs had significantly higher patient satisfaction (90.81% vs 52.94%), hamstring strength (85.01% vs 63.95%), Lower Extremity Functional Scale scores (72.77 vs 69.53), and single-legged hop test results (119.1 vs 56.62 cm) (all P < .001); complications occurred in 23.17% of cases. Compared with chronic repairs, acute avulsion repairs had greater patient satisfaction (95.48% vs 83.79%), less pain (1.07 vs 3.71), and greater strength (85.2% vs 82.8%), as well as better scores for the Lower Extremity Functional Scale (75.64 vs 71.5), UCLA activity scale (University of California, Los Angeles; 8.57 vs 8.10), and Single Assessment Numeric Evaluation (93.36 vs 86.50) (all P < .001). Compared with partial avulsion repairs, complete avulsion repairs had higher patient satisfaction (89.64% vs 81.35%, P < .001), less pain (1.87 vs 4.60, P < .001), and higher return to sport or preinjury activity level, but this was insignificant (81.43% vs 73.83%, P = .082). Partial avulsion repairs had better hamstring strength (86.04% vs 83.71%, P < .001) and endurance (107.13% vs 100.17%, P < .001). Complete repairs had significantly higher complication rates (29.38% vs 11.27%, P = .001). Conclusion: Proximal hamstring avulsion repair resulted in superior outcomes as compared with nonoperative treatment, although the complication rate was 23.17%. The nonoperative group was quite small, making a true comparison difficult. Acute repairs have better outcomes than do chronic repairs. Complete avulsion repairs had higher patient satisfaction, less pain, and a higher complication rate than partial avulsion repairs, although partial avulsion repairs had better hamstring strength and endurance. Studies of high methodological quality are lacking in terms of investigating the outcomes of proximal hamstring avulsion repairs.

Exploring the Perth Hamstring Assessment Tool and Lower Extremity Functional Scale in a Proximal Hamstring Avulsion Cohort: A Cross-sectional Study

2021 ◽  
pp. 036354652110085
Author(s):  
Elsa Pihl ◽  
Kenneth B. Jonsson ◽  
Mida Berglöf ◽  
Nina Brodin ◽  
Olof Sköldenberg ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Assessment Tool ◽  
Patient Specific ◽  
Activity Limitations ◽  
Functional Tests ◽  
Functional Scale ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring ◽  
Lower Extremity Functional Scale

Background: The goal of treatment for a proximal hamstring avulsion (PHA) is an objectively restored muscle and a subjectively satisfied, pain-free patient at follow-up. Different self-reported and performance-based outcome measures have been used to evaluate recovery, but their validity is poorly investigated. Purpose: To investigate 1) the correlation between the commonly used self-reported outcome measurements, the Perth Hamstring Assessment Tool (PHAT) and the Lower Extremity Functional Scale (LEFS); 2) to what extent these scores can be explained by physical dysfunction as measured by performance-based tests; 3) whether performance-based tests can discriminate between the injured and uninjured extremity; and 4) which activity limitations are perceived by patients several years after the injury. Study design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We included a consecutive series of patients treated for or diagnosed with PHA in our department between 2007 and 2016 having at least 2 tendons avulsed from the ischial tuberosity. Participants attended 2 study visits, answered questionnaires (PHAT, LEFS, and Patient-Specific Functional Scale [PSFS]), and performed physical performance–based tests (single-leg hop tests, single–step down test, and isometric and isokinetic strength tests). Results: A total of 50 patients were included (26 men [52%], 24 women [48%]; mean age, 50.9 years [SD, 9.8 years]). The mean follow-up time was 5.5 years (SD, 2.7 years), and 74% had been surgically treated. The correlation between PHAT and LEFS was strong ( r = 0.832) and statistically significant ( P < .001). Seven of the performance-based tests exhibited a statistically significant but weak correlation with LEFS (0.340-0.488) and 3 of the tests to PHAT (–0.304 to 0.406). However, only peak torque could significantly discriminate between the extremities. The activity limitation most commonly mentioned in PSFS was running (16 patients [32%]). Conclusion: Although PHAT and LEFS correlated strongly, the correlations between functional tests and the patient-reported outcome scores were weak, and most functional tests failed to discriminate between the injured and uninjured lower extremity in patients with PHA 5 years after injury. In general, patients alleged few activity limitations, but running difficulty was a common sequela after PHA.

scholarly journals Systematic Review of Outcome Measures Used After Proximal Hamstring Repair

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110051
Author(s):  
Tara Reza ◽  
Andrew J. Hinkle ◽  
Andre Perez-Chaumont ◽  
Symone M. Brown ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Return To Sport ◽  
Measure Data ◽  
Strength Testing ◽  
Functional Scale ◽  
Proximal Hamstring ◽  
Lower Extremity Functional Scale

Background: Patient-reported outcome measures are important to determine outcomes after orthopaedic procedures. There is currently no standard for outcome measures in the evaluation of patient outcomes after proximal hamstring repair. Purpose: To identify and evaluate outcome measures used after proximal hamstring repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed to identify all English-language articles assessing outcomes after proximal hamstring repair in PubMed, Embase, CINAHL via EBSCOhost, MEDLINE via OvidSP, and Web of Science between 2000 and 2019. After duplicates were removed, studies were selected using eligibility criteria established by the authors. Image reviews, anatomic/histology studies, literature reviews, surgical technique reports, systematic reviews, narrative reviews, case studies, and studies with <5 patients were excluded. Extraction, synthesis, and analysis of outcome measure data were performed using Microsoft Excel. Quality assessment of included studies was performed using Methodological Index for Non-Randomized Studies criteria. Results: After duplicate articles were removed, a total of 304 unique articles were identified and 27 met the inclusion criteria. The mean number of patients with proximal hamstring repairs per study was 40. The most frequently reported outcome measures were return to sport (14/27; 51.9%), custom survey/questionnaire (13/27; 48.1%), and isokinetic hamstring strength testing (13/27; 48.1%). Six of the 10 most commonly used outcome measures were validated and included Lower Extremity Functional Scale, 12-Item Short Form Health Survey, visual analog scale for pain, Perth Hamstring Assessment Tool (PHAT), Single Assessment Numeric Evaluation, and Tegner Activity Scale. Of those, PHAT was the only validated outcome measure designed for proximal hamstring repair. Conclusion: There is currently no consensus on the best outcome measurements for the evaluation of patients after proximal hamstring repair. We recommend an increased commitment to the use of return to sport, isokinetic strength testing, Lower Extremity Functional Scale, and PHAT when assessing such injuries. Future studies should aim to define the most reliable methods of outcome measurement in this patient population through consistent use of tools that are clinically relevant and important to patients and can easily be employed in a variety of clinical scenarios.

Rasch analysis of the Lower Extremity Functional Scale for foot and ankle patients

2018 ◽  
Vol 41 (24) ◽  
pp. 2965-2971 ◽  
Author(s):  
Jussi P. Repo ◽  
Erkki J. Tukiainen ◽  
Risto P. Roine ◽  
Mika Sampo ◽  
Henrik Sandelin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Rasch Analysis ◽  
Foot And Ankle ◽  
Functional Scale ◽  
Lower Extremity Functional Scale

The Lower Extremity Functional Scale Has Good Clinimetric Properties in People With Ankle Fracture

2009 ◽  
Vol 89 (6) ◽  
pp. 580-588 ◽  
Author(s):  
Chung-Wei Christine Lin ◽  
Anne M. Moseley ◽  
Kathryn M. Refshauge ◽  
Anita C. Bundy
Keyword(s):  
Lower Extremity ◽  
Internal Consistency ◽  
Ankle Fracture ◽  
Activity Limitation ◽  
Medium Term ◽  
Short Term ◽  
Functional Scale ◽  
High Internal Consistency ◽  
Lower Extremity Functional Scale

Background: There is limited information on the clinimetric properties of questionnaires of activity limitation in people after ankle fracture.Objective: The purpose of this study was to investigate the clinimetric properties of the Lower Extremity Functional Scale, an activity limitation questionnaire, in people with ankle fracture.Design: This was a measurement study using data collected from 2 previous randomized controlled trials and 1 inception cohort study.Methods: Participants with ankle fracture (N=306) were recruited within 7 days of cast removal. Data were collected at baseline and at short- and medium-term follow-ups. Internal consistency and construct validity were assessed using Rasch analysis. Concurrent validity, responsiveness, and floor and ceiling effects were evaluated.Results: The Lower Extremity Functional Scale demonstrated high internal consistency (α&gt;.90). The variance in activity limitation explained by the items was high (98.3%). Each item had a positive correlation with the overall scale, and most items supported the unidimensionality of the scale. These findings suggest that the scale has high internal consistency and construct validity. The scale also demonstrated high concurrent validity and responsiveness in the short term and no floor or ceiling effects. However, the scale would benefit from more-challenging items, as evident at the medium-term follow-up.Limitations: This was a secondary analysis of existing data sets.Conclusion: The Lower Extremity Functional Scale is a useful tool to monitor activity limitation in people with ankle fracture up to the short-term follow-up. More- difficult items may need to be added to improve the responsiveness of the scale for longer-term follow-up.

Measurement properties of the lower extremity functional scale: a systematic review

Physiotherapy ◽  
2015 ◽  
Vol 101 ◽  
pp. e992-e993 ◽  
Author(s):  
S.P. Mehta ◽  
A. Fulton ◽  
C. Quach ◽  
M. Thistle ◽  
C. Toledo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Measurement Properties ◽  
Functional Scale ◽  
Lower Extremity Functional Scale

scholarly journals Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

2016 ◽  
Vol 39 (12) ◽  
pp. 1228-1234 ◽  
Author(s):  
Jussi P. Repo ◽  
Erkki J. Tukiainen ◽  
Risto P. Roine ◽  
Outi Ilves ◽  
Salme Järvenpää ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Reliability And Validity ◽  
Functional Scale ◽  
Lower Extremity Functional Scale

Effects of patient navigation on satisfaction with cancer care: A systematic review.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18088-e18088
Author(s):  
Pascal Jean-Pierre
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Systematic Reviews ◽  
Cancer Care ◽  
Methodological Quality ◽  
Patient Navigation ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Quality Data ◽  
Optimal Health

e18088 Background: Patient navigation (PN) is a model of health care coordination designed to ameliorate health disparities by reducing barriers to achieving optimal health outcomes. Systematic reviews that evaluate whether PN is associated with higher patient satisfaction with cancer care are lacking. Methods: We conducted a systematic review to synthesize evidence of comparative studies evaluating the effectiveness of PN programs to improve satisfaction with cancer-related care. We included studies reported in English that: 1) evaluated a PN intervention designed to increase satisfaction with cancer care; and 2) involved a randomized controlled trial (RCT) or observational design. We abstracted data from studies using standardized forms, and evaluated these studies for methodological quality. Data were summarized qualitatively and synthesized under a random effects model. Results: The initial search yielded 831 citations, of which 3 RCTs and 6 observational studies met inclusion criteria. These nine studies involving 4,200 surveyed patients revealed either a neutral or positive effect in patient satisfaction in the majority of studies of PN and cancer-related care. However, only 5 studies (1 RCT and 4 observational) had adequate datato include in the meta-analysis. Methodological quality of eight of the included studies ranged from weak to moderate to strong, with half rated as weak. Findings of the RCT showed a statistically significant increase in satisfaction with cancer care involving PN [standardized mean difference (SMD) = 2.30; 95% Confidence Interval (CI): 1.79, 2.80, p < .001]. Pooled results from non-RCTs showed no significant association between PN and satisfaction with cancer-related care (SMD = 0.39; 95% CI: -0.02, 0.80, p = .06). Conclusions: More systematic reviews are needed to characterize the relationship between PN and satisfaction with cancer-related care across the cancer care continuum and across different types of cancer.

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